糖尿病肾病维持性血液透析患者情绪障碍及影响因素回顾性研究

A retrospective study of mood disorders in diabetic nephropathy patients with maintenance hemodialysis and their influencing factors

摘要:

目的：分析糖尿病肾病血液透析患者情绪障碍情况及其危险因素，为患者临床治疗与心理疏导提供依据。方法：收集重庆医科大学附属第一医院维持性血液透析治疗的150例糖尿病肾病患者，同时选择同期进行血液透析的年龄性别匹配的非糖尿病肾病患者150例作为对照，收集患者的临床资料、生化指标，用Zung焦虑自评量表（self rating anxiety scale，SAS）、Zung抑郁自评量表（depression self rating scale，SDS）调查2组的情绪障碍，分析糖尿病肾病血透患者情绪障碍的相关因素。结果：2组患者的年龄、性别无明显差异；糖尿病血液透析患者的焦虑和抑郁发生率及睡眠评分均明显高于非糖尿病血透患者，差异有统计学意义（P=0.000）。在糖尿病肾病血透患者中，女性情绪障碍的人数明显高于非情绪障碍的人数（P=0.000）；但糖尿病肾病透析患者情绪正常组与障碍组患者血红蛋白、血浆白蛋白、血清钙、血清磷、全段甲状旁腺激素（intact parathyroid hormone，iPTH）、单室尿素清除率（single compartment urea clearance rate，spKt/V）水平无统计学差异（P＞0.05）；情绪障碍组的心血管、脑血管并发症、不宁腿、皮肤瘙痒、睡眠障碍和骨骼疼痛发生率明显高于正常组，差异有统计学意义（P<0.05）。结论：糖尿病肾病患者血透期间易出现情绪障碍，女性、心血管疾病、脑血管疾病、骨骼疼痛等并发症及社会支持低是血透糖尿病肾病患者情绪障碍的独立危险因素。

Abstract:

Objective：To analyze the mood disorder and its influencing factors in diabetic nephropathy patients with maintenance hemodialysis，so as to provide evidence for the clinical treatment and psychological counseling of patients. Methods：A total of 150 patients with diabetic nephropathy received maintenance hemodialysis in our hospital were selected，and 150 non-diabetic nephropa－thy patients with matching age and gender received hemodialysis were selected. Clinical data and biomedical data were collected. Zung self rating anxiety scale（SAS） and Zung depression self rating scale（SDS） were used to survey mood disorders in two groups，to analyze the related factors of mood disorders in diabetic nephropathy patients with hemodialysis. Results：There was no significant difference in age and gender between two groups. Among the 150 diabetic nephropathy patients with hemodialysis，the incidence of anxiety and depression and sleeping scores were higher than those in non-diabetic nephropathy patients，with statistically significant differences（P=0.05）. Among diabetic nephropathy patients with hemodialysis，the number of women with mood disorders was signif－icantly higher than that without mood disorders（P=0.000）；but differences in hemoglobin，serum albumin，serum calcium，serum phosphorus，iPTH，single compartment urea clearance rate（spKt/V） level of diabetic nephropathy patients in the normal group and the depression group had no statistical significance（P>0.05）. Cardiovascular and cerebrovascular complications，restless legs，skin itching，sleep disorder and bone pain in the depression group were significantly higher than those in the normal group，with statistically signif－icantly differences（P<0.05）. Conclusion：Patients with diabetic nephropathy are prone to have emotional disorders during hemodialysis，and female，cardiovascular disease，cerebrovascular disease，bone pain and other complications as well as low social support are independent risk factors for mood disorders in diabetic nephropathy patients with hemodialysis.